2016 CHIBICHAN BASKETBALL Clinic Registration Form
Join us for the 23rd season of our basketball clinic! Sponsored by the Seattle Betsuin Dharma School, this program is open to all boys and girls ages 4 –10 years old. Participate in a non-competitive setting where the emphasis is on skill development, sportsmanship, participation and having fun! Team photo and coach’s gift are included with registration.
Dates (5): Oct. 2, 9, 16, 23 (picture day), Nov. 6 (11/6 Daylight savings ends)
Place: Seattle Buddhist Church Gym, 1427 S. Main St., Seattle, 98144
Time: There will be two sessions between 11:40am and 1:15pm. We will determine the times after we know the number of children in each group. Each group will have approximately 30 minutes of gym time. The clinic will end by 1:15 PM. The clinic will be divided into the following groups: Nezumi (4-5 yr olds), Nekko (6 yr olds), Tora (7 yr olds) and Ninja (8-10 yr olds).
Registration Fee: $30 – Church Members (Member dues current) / $40 – Non-Church Members
Registration will begin on 9/11/16
What to bring: A labeled water bottle, Nekko, Tora & Ninja students are encouraged to bring their own basketball (labeled), if you have one. (There is no need to purchase a ball though; we do have extra ones.) Nekko will play with the intermediate/women’s size (28.5); Tora will play with either the intermediate/women’s or the men’s; and Ninja play with the standard men’s size (29.5).
To provide a safe, fun & effective coaching environment, we will be limiting the number of participants this year. Deadline to register is 9/28/16. We will not be able to accept late requests. Please make checks payable to “Seattle Betsuin Dharma School”. All proceeds will go to the Dharma School fund.
To provide a safe, fun & effective coaching environment, we will be limiting the number of participants this year. Deadline to register is 9/28/16. We will not be able to accept late requests. Please make checks payable to “Seattle Betsuin Dharma School.” All proceeds will go to the Dharma School fund.
Please turn in completed registration and check to:
Seattle Betsuin Dharma School
C/O Erin Taylor
1427 S. Main St
Seattle, WA 98144
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2016 Dharma School Chibichan Basketball Program
Child Name ________________________________________ Age ______ on September 1, 2016
Group (circle one): Nezumi (4 & 5 Yr) Nekko (6 Yrs) Tora (7 Yrs) Ninja (8 – 10 Yrs)
Address _____________________________________________________________
Parent Name _________________________________________________________
Phone ___________________________ Email ____________________________
Emergency Contact: ______________________________ Phone: ________________
Medical Conditions? (allergies, asthma, etc.)_________________________________
Consent Form:
I hereby give my consent for ________________________ to participate in the Seattle Betsuin Dharma School Chibichan basketball program. I understand the risks inherent in this class, and declare that I will not hold the Seattle Betsuin Buddhist temple, Dharma school or any of the coaches responsible for any injury that may be suffered by the participant arising out of or in any way connected with this activity. In case of emergency, the coaching staff has my permission to take my child to the nearest medical facility, doctor or dentist for emergency treatment.
Signed__________________________________ (parent or guardian)
Date ______